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Utilization of Axillary Surgery for Patients With Ductal Carcinoma In Situ: A Report From the National Cancer Data Base

  • Breast Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

This study evaluated the use of axillary surgery (AS), including sentinel lymph node biopsy (SLNB), for patients with ductal carcinoma in situ (DCIS) and the factors associated with its use. To determine whether utilization of SLNB is appropriate, predictors of SLNB performance were compared with factors predictive of tumor upstaging.

Methods

The National Cancer Data Base was utilized to identify patients with American Joint Committee on Cancer (AJCC) clinical stage 0 breast cancer treated from 2004 to 2013. DCIS with microinvasion was excluded. Chi square tests and logistic regression were used to examine patient, tumor, and facility features associated with SLNB and tumor upstaging.

Results

Of the 218,945 total patients, 155,093 (70.8 %) underwent lumpectomy, and 63,852 (29.2 %) underwent mastectomy. SLNB was performed for 19.0 % of lumpectomy patients and 63.5 % of mastectomy patients. Multivariate analysis for 2012–2013 demonstrated that estrogen receptor (ER)-negative and grade 3 tumors were more likely to be treated with SLNB in both groups. Tumor size was significant only for the lumpectomy patients who underwent one operation. Further, 22.8 % of lumpectomy patients and 18.7 % of mastectomy patients who underwent AS were upstaged compared with 1.8 % of lumpectomy and 3.6 % of mastectomy patients who did not undergo AS. Tumor upstaging was predicted by ER-negative status (odds ratio [OR] 2.99; 95 % confidence interval [CI] 2.76–3.24) but not by higher grade or larger tumor size.

Conclusions

Use of SLNB for DCIS is high with mastectomy, and nearly one fifth of the lumpectomy patients underwent SLNB. However, the performance of AS was strongly associated with the likelihood of upstaging in both groups, suggesting that surgical judgment plays an important role in this decision.

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Disclosures

There are no conflicts of interest.

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Authors and Affiliations

  1. Department of Surgery, The University of Chicago Medicine, Chicago, IL, USA

    Megan E. Miller MD, Olga Kantor MD & Jennifer Tseng MD

  2. Department of Surgery, NorthShore University HealthSystem, Evanston, IL, USA

    Alexandra Kyrillos BS, Katharine Yao MD & David J. Winchester MD

  3. Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA

    Lawrence N. Shulman MD

Authors
  1. Megan E. Miller MD
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  2. Alexandra Kyrillos BS
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  3. Katharine Yao MD
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  4. Olga Kantor MD
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  5. Jennifer Tseng MD
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  7. Lawrence N. Shulman MD
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Correspondence to Katharine Yao MD.

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Miller, M.E., Kyrillos, A., Yao, K. et al. Utilization of Axillary Surgery for Patients With Ductal Carcinoma In Situ: A Report From the National Cancer Data Base. Ann Surg Oncol 23, 3337–3346 (2016). https://doi.org/10.1245/s10434-016-5322-0

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  • DOI: https://doi.org/10.1245/s10434-016-5322-0

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